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Melanoma is the most aggressive skin cancer that has a tendency of early lymphatic and hematogenous metastasis. Surgical excision constitutes as a methods of treatment. Early diagnosis is the key to successful treatment of melanoma, which is primarily associated with Breslow and Clark grading. The aim of this study was to investigate these and other prognostic parameters such as the age, the gender and the anatomical distribution of melanoma, macroscopic and histological type of melanoma, the size and the remains of the tumor tissue at the surgical margins. We analysed biopsy material of Institute of Pathology, Faculty of Medicine in Pristina from 2004 to 2017. year. We found that melanoma were more common at older men (average age of 68.5 ± 14.6 years), most common location was back, head and neck, upper and lower extremities, where were frequent occurrence of metastasis (Clark IV). Larger tumors require a wider excision. The greatest incidence was nodular type melanoma and predominant histological were epitheloid type melanoma. Between the size of the tumor masses and the depth of invasion there were no statistically significant positive correlation, which leads to the conclusion that the Clark and Breslow can be used as prognostic factors because they are mutually comparable.

Background: Neuromodulatory applications such as vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) are safe and effective strategies for medically intractable epilepsy secondary to complex partial seizures, but researchers have yet to compare their efficacies. Objective: The goal of this study is to compare VNS and RNS efficacy at reducing seizure frequency and complication rates in subjects with medically intractable epilepsy secondary to complex partial seizures. Methods: This is a retrospective chart review of 30 patients with medically intractable complex partial epilepsy, who underwent either VNS or RNS placement at a single institution between June 2012 and January 2016. There was a mean follow-up of 19 months. Seizure frequency reduction and complications were identified. Results: The median seizure frequency reduction was similar for VNS (66%) and RNS (58%). There was no major morbidity or mortality, and the frequency of minor complications was similar between VNS (15%) and RNS (18%). Conclusion: We found that VNS and RNS reduced the median seizure frequency similarly with no difference in morbidity or mortality. Further prospective studies are warranted as VNS and RNS therapy improves over time.

Objective: To investigate autonomic symptoms in different types of epilepsy in comparison to control subjects. To observe whether autonomic symptoms cause possible morbidity and mortality and to make a preliminary remedy Patients and Methods: A retrospective chart review was conducted for 28 patients diagnosed with epilepsy including 18 patients with complex partial epilepsy (CPE) and 10 patients with primary generalized epilepsy (PJE). Their autonomic symptoms were assessed using the COMPASS-31 questionnaire in comparison to a control group of 18 subjects. Results: No statistically significant differences were found in autonomic dysfunction symptoms between patients with CPE and patients with PJE. However, constipation and insomnia which autonomic symptoms were statistically significantly more common in epileptic patients compared to the control group. Conclusions: It is important to recognize and watch out for symptoms of autonomic dysfunction in patients with epilepsy. We believe that awareness for these symptoms is essential both to reduce associated disability and develop specific treatment strategies and to predict sudden unexpected death in epileptic patients.

Resume Introduction Plusieurs travaux ont montre qu’une resection au niveau du lobe temporal (RT), pratiquee dans le cas d’une epilepsie du lobe temporal median (ELT) pharmaco-resistante, peut se traduire par un declin des performances en memoire anterograde ou memoire du passe. Cependant, la plupart de ces travaux n’ont pas utilise de criteres d’inclusion stricts pour constituer des groupes de patients homogenes. Dans la presente etude, nous avons evalue l’impact d’une RT sur les performances mnesiques en realisant un suivi neuropsychologique longitudinal de patients atteints d’ELT, patients selectionnes selon des criteres demographiques et cliniques restreints. Methode Trente patients atteints d’ELT unilaterale (17 droites et 13 gauches) ont ete evalues a 4 tests de memoire anterograde et a six tests de memoire du passe, trois mois avant la RT, ainsi que cinq mois et 12 mois apres l’operation. Resultats Suite a la RT, les performances en memoire anterograde sont ameliorees un an apres l’operation. Seuls les patients operes dans l’hemisphere droit ameliorent leur memoire autobiographique. Conclusions Une amelioration postoperatoire des capacites mnesiques a ete observee des lors que les patients presentaient des caracteristiques cliniques specifiques.

Resume Un homme de 37 ans, atteint d’epilepsie temporale, presente des episodes psychiatriques atypiques, transitoires, entrecoupes d’intervalles libres. Ces troubles du comportement ne peuvent etre uniquement expliques par l’epilepsie temporale. L’hypothese avancee est celle d’un syndrome de Kluver-Bucy avec hypersexualite, agnosie visuelle et emoussement affectif. Ce syndrome secondaire a un dysfonctionnement bilateral et transitoire des lobes temporaux serait induit par une crise partielle complexe.

La survenue de crises chez des patients epileptiques n’est pas toujours un phenomene completement aleatoire. Parmi les facteurs favorisants, le stress et, d’une facon plus generale, le contexte emotionnel sont les circonstances le plus souvent rapportees par les patients. Nous avons plus particulierement etudie cette « vulnerabilite emotionnelle » a travers une approche clinique et cognitive. Nous avons pu montrer que bien que basee sur une appreciation subjective, cette vulnerabilite etait associee a des marqueurs de type « biais attentionnels » pour les informations emotionnelles. De plus, les patients vulnerables sont plus souvent des femmes et ont debute leur epilepsie apres un evenement emotionnel marquant.

Plusieurs des caracteristiques morphologiques et electrocliniques de l’epilepsie mesiotemporale (EMT) peuvent etre reproduites chez la souris adulte par l’injection unilaterale d’une faible dose de kainate (KA) dans l’hippocampe dorsal. Apres un etat de mal initial et une periode latente de deux semaines, les souris developpent des decharges recurrentes et des remaniements morphologiques dans l’hippocampe semblables a la sclerose de l’hippocampe. L’EMT etant souvent associee a une resistance a plusieurs medicaments anti-epileptiques, nous avons evalue dans ce travail les effets de quatre molecules (diazepam, valproate, carbamazepine et lamotrigine) sur les decharges hippocampiques recurrentes. Seul le diazepam (0,5-3 mg/kg, i.p.) supprime de facon dose-dependante les decharges hippocampiques. Le valproate (100-400 mg/kg), la carbamazepine (25-100 mg/kg) et la lamotrigine (30-90 mg/kg) ne suppriment les crises qu’a la plus forte dose. A ces doses, le trace EEG est fortement perturbe, et les animaux presentent des signes d’incapacitation motrice. Ces resultats montrent que les decharges hippocampiques chez la souris sont resistantes aux anti-epileptiques classiques et suggerent que ce modele d’EMT constitue un outil d’evaluation pharmacologique de cette forme d’epilepsie.

UMMARY The authors report an 11-year-old girl with epilepsy, poor school-performance and minor behavioural disorders. The epilepsy is characterized by complex partial seizures, sometimes progressing secondarily into generalized tonic-clonic seizures. and is poorly controlled by medical treatment. Chromosomal analysis revealed a ring chromosome 20 mosaicism. The affected patient shows signs of ring chromosome 20 syndrome, characterized in the present case by poor school-performance, behavioural disorders and epilepsy. RESUME Mosaiqire dhn chromosome 20 circiilaire ctrez une fillerie presentant des crises partielles coniplexes Les auteurs rapportent l e cas d'une fillette de 11 ans presentant une epilepsie, des resultats scolaires mediocres et des troubles comportementaus mineurs. Ľepilepsie etait caracterisee par des crises partielles complexes quelquefois secondairement generalisees en crises tonico-cloniques globales et etait mal controee par le traitement. Ľ analyse chromosomique revela une rnosaique ď un chroniosonie 20 en anneau. La fillette rnontrait les signes ď un syndrome r(2O) caracterise dans le cas present par des resultats scolaires mediocres, des troubles comportementaux et une epilepsie. ZUSAMMENFASSUNG Mosaik des Ringchromosonrs 20 bei ernem Madchen mil komplexen Partiulunfallen Die Autoren berichten uber ein 11-jahriges Madchen mit Epilepsie, schlechten Schulleistungen und leichten Verhaltensstorungen. Die Epilepsie ist charakterisiert durch komplexe Partialanfalle, die manchmal in generalisierte tonisch-klonische Anfalle ubergehen und die medikarnentos schlecht zu kontrollieren sind. Die Chromosomenanlyse ergab ein Mosaik des Ringchromosoms 20. Die Patientin hatte Zeichen des r(20) Syndroms, die sich in ihrem Fall in schlechten Schulleistungen, Verhaltensstorungen und Epilepsie auserten. RESUMEN Mosaicismo con cromosoim 20 en unillo en una niaa con crisis parciales cornplejas Los autores aportan el caso de una nina de 11 anos con epilepsia, escolaridad pobre y alteraciones menores del comportarniento. La epilepsia se caracteriza por ataques parciales complejos, en ocasiones con generalization secundaria en forma de convulsiones tonico-clonicas, y que se controlan pobremente con la medicacion. El cariotipo revelo un mosaicismo con un cromosoma 20 en anillo. El paciente muestra signos de un sindrome de r(20), caracterizado en este caso por dificuftad. escolar, alteraciones en el comportamiento y epilepsia.

Introducción: La etiología de la epilepsia del lóbulo temporal (ELT) en la edad pediátrica se ha descrito en escasas ocasiones. El propósito de este estudio es analizar el diagnóstico etiológico de 61 pacientes con ELT atendidos en una consulta de neurología infantil. Analizamos y comentamos la clasificación actual. Pacientes y métodos: Se trata de un estudio de carácter retrospectivo, en el que se incluyó a 61 pacientes con ELT. Resultados: Los pacientes fueron clasificados en tres grupos en función del diagnóstico etiológico: grupo 1 (ELT sintomática), incluye a 25 pacientes (40,98%) con lesiones en el lóbulo temporal (malformación, tumor o infección) o antecedentes significativos para presentar epilepsia; grupo 2 (esclerosis mesial temporal [EMT]), incluye a 17 pacientes (27,86%), el antecedente de crisis febriles (tanto simples como complejas) se encontraba presente en un porcentaje elevado de pacientes con EMT; grupo 3 (ELT criptogénica), incluye a 19 pacientes (31,15%), sin hallazgos patológicos en la resonancia magnética (RM) craneal o antecedentes significativos. Conclusión: Hasta la fecha, es la mayor serie que analiza, mediante RM, la etiología de la ELT de comienzo en la edad pediátrica. Hemos pretendido matizar la clasificación etiológica más aceptada, con el propósito de hacer grupos más flexibles y realistas. : Introduction: There are very few studies on the aetiology of temporal lobe epilepsy (TLE) in childhood. The purpose of the present study is to analyse the data of 61 children diagnosed with TLE, in order to describe the aetiology of TLE in children seen in a neuropaedriatic clinic. We also discuss the currently proposed classification. Patients and methods: A retrospective analysis was carried out on patients diagnosed with TLE. Patients consisted of 61 children less than 15 years old. Results: Patients were classified into three groups: Group 1 (symptomatic temporal lobe epilepsy) consisted of 25 patients (40.98%) with any temporal lesion on neuroimaging (tumours, malformations or infections) or significant history; Group 2 (Mesial temporal sclerosis) consisted of 17 patients (27.86%), a history of simple and complex febrile seizure were common in this group; and Group 3 (Cryptogenic epilepsy) consisted of 19 patients (31.15%) with no abnormalities on neuroimaging or significant history. Conclusion: To our knowledge, this is the largest paediatric series of childhood new-onset TLE assessed only by MRI in the literature. We have modified the previous aetiological classification in order to make the groups more realistic.

Surgery for refractory temporal lobe epilepsy is established as a promising treatment option. Although practiced for decades now, there is an ongoing discussion on who is a candidate, when we should operate, how the preoperative evaluation and surgery should be performed, and what perspective will result for the individual after surgery. In light of significant improvements with respect to safety and outcome, generally accepted features will be extracted, and some more ambivalent aspects will be discussed. Major future developments in this field will be based on multimodal imaging and correlation with electro-clinical and neuropsychological findings.

Seizures induced by fever (febrile seizures) are the most common type of pathological brain activity in infants and children. These febrile seizures and their potential contribution to the mechanisms of limbic (temporal lobe) epilepsy have been a topic of major clinical and scientific interest. Key questions include the mechanisms by which fever generates seizures, the effects of long febrile seizures on neuronal function and the potential contribution of these seizures to epilepsy. This review builds on recent advances derived from animal models and summarizes our current knowledge of the mechanisms underlying febrile seizures and of changes in neuronal gene expression and function that facilitate the enduring effects of prolonged febrile seizures on neuronal and network excitability. The review also discusses the relevance of these findings to the general mechanisms of epileptogenesis during development and points out gaps in our knowledge, including the relationship of animal models to human febrile seizures and epilepsy.

More than 20 years ago, complex partial epilepsy of occipital-temporal origin was suggested as having been the “nervous disease” of Gustave Flaubert, one of the most famous French novelists. The aim of the present work, therefore, was to reevaluate the diagnosis of Flaubert’s “nervous disease” in the light of reemerged biographic information and letters, as well as the numerous scientific advances in epilepsy and its psychopathology in recent years. If the semiology of the reported attacks is considered, epilepsy ranks among the most probable diagnoses. In our opinion, psychopathological considerations suggest primary involvement of mesial temporal lobe structures with typical findings of ictal and interictal mood behavior.

An 18-year-old woman with a history of refractory complex partial epilepsy presented for evaluation of snoring and episodes of gasping for air during sleep. She had uncontrolled epilepsy since the age of 8 years despite trial of multiple antiepileptic medications. She eventually underwent an implantation of a vagus nerve stimulator (VNS) device (model 103; Cyberonics Inc) with gradual adjustment of the VNS settings for better seizure control.

Resume Introduction Les propagations des crises d’epilepsie partielle se font selon un schema spatio-temporel propre a chaque localisation cerebrale. Caracteriser ce schema peut aider a mieux definir cette localisation. Dans les epilepsies de la face mediale du lobe temporal, l’etude des propagations s’est focalisee sur le passage des crises vers le lobe temporal controlateral. Etat des connaissances . L’analyse de ces propagations s’est faite au mieux grâce aux enregistrements EEG intracrâniens. Les sequences de propagation des crises d’origine medio-temporale aux structures ipsi-, puis controlaterales, diversement appreciees selon les auteurs, ont conduit a incriminer plusieurs voies de passage interhemispherique possibles : les trois commissures liant les lobes temporaux (corps calleux, commissure hippocampique dorsale et commissure anterieure) et un circuit indirect passant par les lobes frontaux. D’autre part, les vitesses de propagation des crises d’origine temporo-limbique sont lentes, le delai inter-temporal moyen est d’environ 30 secondes, avec cependant une forte variabilite. Cette lenteur pourrait etre liee en partie a la rarete des connexions commissurales des structures temporo-limbiques entre elles chez l’homme. A l’inverse, les regions medio-temporales paralimbiques (rhinales et polaires) sont fortement connectees par voie commissurale et des temps de transfert inter-temporal de l’ordre de 100 ms ont ete mesures pour une decharge epileptique induite a partir du cortex perirhinal anterieur. Il existe donc des possibilites de passage extremement rapide inter-medio-temporal a partir des regions paralimbiques anterieures, passant vraisemblablement par la commissure anterieure. Perspectives . Les modalites de propagation des crises d’origine medio-temporale restent debattues. Pourtant elles conditionnent par leur extension et vitesse la semiologie electroclinique des crises et notre capacite a discerner l’origine des decharges epileptiques. Leur etude merite d’etre poursuivie. Conclusions . La conception duelle des propagations inter-medio-temporales, selon leur vitesse et lieu d’origine, s’appuie sur un faisceau d’arguments neurophysiologiques et anatomiques concordants developpes dans cette revue.

Resume Introduction La memoire du passe, contrairement a la memoire anterograde, rarement ete examinee dans l’epilepsie du lobe temporal et jamais avant et apres traitement chirurgical. Par ailleurs, les etudes de cas rapportant un deficit de la memoire des faits publics avec une preservation de la memoire autobiographique sont tres rares. Methodes Nous presentons le cas d’un patient atteint d’une epilepsie temporale pharmacoresistante en rapport avec une sclerose hippocampique gauche. Des examens neuropsychologiques complets ont ete realises avant et apres lobectomie temporale, avec un interet particulier pour la memoire du passe, evaluee exhaustivement au moyen de tests standardises, mais egalement d’epreuves adaptees au patient. Resultats Le patient presentait une memoire preservee pour les faits et episodes autobiographiques, mais des scores deficients aux tests de faits publics, dans un contexte de capacites cognitives generales normales. De plus, un oubli accelere pour du materiel verbal et non verbal etait mis en evidence. Conclusion Les resultats suggerent que le trouble de consolidation a long terme pourrait avoir contribue au deficit de la memoire des faits publics. Nous discutons les caracteristiques specifiques du traitement des faits publics en essayant d’expliquer sa plus grande vulnerabilite par rapport a la memoire autobiographique, dans le cas de l’oubli accelere.

Resume L’exerese complete d’une lesion responsable d’une epilepsie permet la disparition ou la reduction importante des crises dans 85 % des cas. Cependant, le pronostic semble moins favorable dans les epilepsies temporales lesionnelles car les structures temporo-mesiales peuvent participer a la genese des crises sans etre le siege de ces lesions. L’analyse electro-clinique et radiologique des patients peut apporter des elements d’orientation en faveur d’une telle implication mais ne semble pas toujours suffisante. Afin d’evaluer les criteres nous ayant conduits au choix de la strategie chirurgicale, nous rapportons une serie retrospective consecutive de 47 patients traites pour une epilepsie temporale pharmaco-resistante symptomatique d’une lesion temporale extra-hippocampique traites soit par lesionectomie seule (groupe 1, n = 17), soit par lesionectomie associee a une resection des structures temporo-mesiales (groupe 2, n = 30). Les cas presentant une sclerose hippocampique associee a la lesion (double pathologie) ont ete exclus de cette etude. Les resultats de cette etude montrent qu’avec un recul moyen de 72 mois, 84 % des patients du groupe 2 ont ete liberes de leur crise (grade Ia de Engel) contre seulement 47 % des patients du groupe 1. L’analyse statistique a identifie le type de chirurgie comme le facteur pronostique preponderant. En conclusion, les criteres electro-cliniques retenus pour evoquer une participation temporo-mesiale dans l’elaboration des crises sont insuffisants pour preciser la strategie chirurgicale. Compte tenu de sa valeur pronostique, l’evaluation de cette participation, parfois complexe, apparait importante a realiser. L’existence d’une double pathologie « fonctionnelle » acquise est evoquee pour expliquer ce resultat.

Background:Clobazam is a benzodiazepine with known antiepileptic action; however, it is not considered first line therapy in the treatment of epilepsy. The objective of this study was to evaluate the efficacy of clobazam as add-on therapy in adults with temporal lobe epilepsy associated with MRI evidence of hippocampal sclerosis (HS).Method:This is a retrospective study, conducted at our epilepsy clinic which evaluated clobazam as add-on therapy in patients with temporal lobe epilepsy and MRI signs of HS. Clobazam was prescribed based on the minimum effective dose up to the maximum tolerated dose.Results:Seventy-eight patients met the inclusion criteria (51 women), ages ranging from 16 to 76 years old (mean=42.2). Dosage of clobazam ranged from 5 to 60 mg/day (mean=22.6 mg/day). Clobazam was used from one month to eight years (mean=29 months). Sixteen (20.5%) patients were seizure-free, 20 (25.5%) had more than 75% improvement in seizure control, eight (10%) had more than 50% and 20 (26%) were non responders to clobazam. In 14 (18%) we could not determine seizure frequency during follow-up. The improvement in seizure control lasted for more than one year in 30 (68%) patients.Conclusion:Our data suggest that clobazam should be considered as add-on therapy in the treatment of patients with temporal lobe epilepsy associated with MRI signs of HS.

Resume Objectifs Lors du bilan morphologique realise par IRM chez les patients ayant une epilepsie temporale refractaire, certaines anomalies de forme de l’hippocampe ont ete individualisees. Leur prevalence est inconnue et leur relation avec l’origine des crises n’est pas etablie. Le but de cette etude est de preciser la semiologie IRM et de determiner l’incidence de ces anomalies, appelees malformations hippocampiques, dans un groupe de patients porteurs d’une epilepsie temporale et dans un groupe de sujets temoins afin de comprendre leur signification. Materiels et methodes Il s’agit d’une etude prospective sur 97 patients atteints d’epilepsie temporale refractaire pour lesquels une IRM a ete realisee dans la phase de selection pre-chirurgicale. Le protocole comportait des coupes coronales obliques sur les lobes temporaux en ponderation T1 inversion recuperation, T2 haute resolution (HR) et FLAIR completees par des sequences FLAIR axial et en inversion recuperation axiale et sagittale sur l’ensemble de l’encephale. Chez 50 sujets temoins ayant participe au protocole il a ete realise des coupes coronales obliques en T2HR. Les deux groupes ont ete evalues a la recherche d’une lesion encephalique et d’anomalie morphologique de l’hippocampe. Les differents criteres retenus pour le diagnostic de malformation hippocampique etaient :un hippocampe medialise et/ou de forme pyramidale, un sillon collateral verticalise, une perte de la visibilite des structures internes. Resultats Quatorze patients (14 %) presentaient des modifications structurales des formations hippocampiques. Les anomalies les plus representees etaient la forme pyramidale (n = 13) et la verticalisation des sillons collateraux (n = 13). D’autre anomalies etaient decrites, comme la position de l’hippocampe (anormale, medialise) (n = 5) et un stratum radiatum non visualise (n = 3). Les malformations hippocampiques dans leur forme la plus complete avec perte de visualisation de la structure interne (absence d’hyposignal lineaire en T2) etaient correlees au foyer electrique (n = 3). La verticalisation du sillon collateral a egalement ete retrouvee dans 6 % (n = 3) des sujets temoins, ainsi qu’une forme pyramidale dans 4 % (n = 2). En revanche les structures internes etaient toujours visualisees. Conclusion Les formes completes de malformation hippocampique avec perte de visualisation de la structure interne de l’hippocampe pourraient etre considerees comme des lesions epileptogenes a part entiere. Cependant, l’interpretation des formes incompletes reste difficile. En effet, la verticalisation du sillon collateral ainsi qu’un hippocampe de forme pyramidale sont retrouves chez le sujet sain et pourraient, en consequence, etre consideres comme des variantes de la normale.

Introduction/Objectif: On peut observer des anomalies diffuses du lobe temporal a l'IRM de patients atteints d'epilepsie du lobe temporal mesial (ELTM). Le but de cette etude etait d'effectuer des analyses qualitatives et quantitatives des structures du lobe temporal chez des patients atteints d'ELTM familiale (ELTMF) et non familiale (ELMT). Methodes: Deux groupes de patients ont ete identifies: 67 patients atteints d'ELMTF, dont 14 avaient des crises refractaires au traitement, et 30 patients atteints d'ELMT non familiale refractaire, Nous avons effectue des analyses qualitatives de l'IRM (avec reconstruction multidimensionnelle) et du volume de l'hippocampe et des lobes temporaux anterieurs chez tous les patients et chez un groupe de temoins normaux comprenant 23 individus. Nous avons utilise le test du c2 et l'ANOVA comme analyses statistiques. Resultats: Nous avons identifie des anomalies du lobe temporal anterieur par analyse visuelle chez seulement 4 % des patients atteints d'ELTMF et une atrophie du lobe temporal anterieur par analyse volumetrique chez 19 % de ces patients. Dans le groupe de patients atteints d'ELTM non familiale, nous avons observe des anomalies du lobe temporal anterieur par analyse visuelle chez 17 % des patients et une atrophie du lobe temporal anterieur chez 13 %. Une atrophie de l'hippocampe etait presente chez 90 % des patients atteints d'ELTMF et chez 83 % des patients atteints de la forme non familiale. Aucun signe de dysplasie corticale n'a ete observe, Conclusion: Une atrophie du lobe temporal anterieur et d'autres anomalies ne touchant pas la partie mesiale des lobes temporaux etaient rares tant chez les cas familiaux que chez les cas non familiaux. Malgre son etiologie genetique, l'atrophie de l'hippocampe n'est pas associee a des anomalies de structures en dehors des regions temporales mesiales dans l'ELTMF.

Background:The lateralizing value of the motor automatisms is generally doubted in most patients with temporal lobe epilepsy. However, subgroup analysis of the seizures of temporal lobe origin suggests a role for motor automatisms in discriminating seizures of neocortical versus mesial temporal lobe origin.Methods:Video-EEG of a patient with well-defined neocortical temporal lobe epilepsy was reviewed to assess the localizing value of motor automatisms.Results:We report a patient with left upper extremity motor automatisms and clonic movements of the proximal left lower extremity with altered awareness as the sole manifestations of right temporal neocortical seizures.Conclusion:Early onset unilateral motor automatisms without dystonic posturing can localize the seizure origin to the contralateral temporal lobe neocortex.

Nuclear magnetic resonance spectroscopy (1H-MRS) is a non-invasive method in detecting abnormal spectra of various brain metabolites containing N-acetylaspartate (NAA), Choline (Cho), Creatine (Cr), gamma-Aminobutyric acid (GABA) and Glutamate. Technical processing of the MR-systems, improved automated shimming methods and further development of special shim coils increase the magnetic field homogeneity and lead to a better spectral quality and spectral resolution. The handling of the systems becomes more user-friendly and is more likely to be used in routine diagnostics. The 1H-MRS has become a diagnostic tool for assessing a number of diseases of the central nervous system mainly including epilepsies and brain tumours. The role of 1H-MRS in the assessment of epilepsies will probably increase in future. In the following article, the principles of 1H-MRS and an overview of it in the evaluation and treatment of epilepsies with special regard to temporal lobe epilepsies (TLE) has been illustrated.

Background: Temporal lobectomy in adults is an accepted form of treatment for patients with intractable complex partial seizures. There have been few long-term studies of children undergoing temporal lobectomy for epilepsy. Methods: We reviewed the pediatric cases of temporal lobectomy for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988 and 2000. All patients had preoperative and postoperative clinical evaluations, seizure charts, drug levels, EEG, CT/MRI, long-term video EEG monitoring and neuropsychological testing. The patients were reassessed at 6 weeks, 6 months and 1 year postoperatively, then yearly. The duration of follow up was 1–10 years (mean 5 years). Results: Forty-two patients were studied (25 males and 17 females). Age at surgery ranged from 18 months to 16 years. The interictal EEG was abnormal in 38 of the 42 patients. Twenty-two patients had focal epileptic discharge and 1 had generalized epileptic discharge. Focal slowing was seen in 9 patients and diffuse slowing in 5 patients. CT scan was abnormal in 17 of 39 patients and normal in 22 of 39. MRI was abnormal in 34 of 42 patients and normal in 8 of 42. Pathology included brain tumors in 14 patients, mesial temporal sclerosis in 8, focal cortical dysplasia in 4, tuberous sclerosis in 4, dual pathology in 4, porencephalic cyst in 1 and normal pathology or gliosis in 6. Thirty-three of 42 patients (78%) were seizure-free following surgery and an additional 5 (12%) had a decrease in seizure frequency. Three patients had complications, but there were no deaths. Conclusion: Temporal lobectomy is a safe and effective treatment for children with intractable complex partial seizures. Seventy-eight percent of patients are seizure-free following the surgery and there are few complications. MRI is superior to CT scan for detection of temporal lobe pathology yet failed to detect abnormalities in some patients. The most common pathologies found were brain tumors, mesial temporal sclerosis and developmental lesions. In addition to seizure control, many patients experienced improvement in cognitive and psychosocial function following surgery.

Diese prospektive Studie untersuchte die Effizienz einer fraktionierten stereotaktischen Radiotherapie (RT) bei therapieresistenter Temporallappenepilepsie. Patienten und Methoden: Einschlusskriterien waren Patienten im Alter von 17 bis 65 Jahren, die weder medikamentos noch epilepsiechirurgisch anfallsfrei wurden und einen einseitigen Fokus aufwiesen. Zwei Patientenkohorten zu je sechs Patienten wurden zwischen 1997 und 1999 einer fraktionierten, stereotaktisch gefuhrten Radiotherapie mit 21 Gy (7 × 3 Gy) bzw. 30 Gy (15 × 2 Gy) unterzogen. Endpunkte der Untersuchung waren Anfallsfrequenz, Intensitat und Dauer sowie neuropsychologische Verlaufsparameter. Ergebnisse: Alle elf auswertbaren Patienten profitierten im Sinne einer Reduktion der Anfallsfrequenz. Die mittlere Reduktion der komplex-partiellen Anfalle betrug im 18. Monat der Nachbeobachtungszeit 37% (9–77%, entsprechend 1–23 Anfalle pro Monat) bzw. 46% (23–94%, entsprechend 0,2–23 Anfalle monatlich) gemittelt uber den 18-monatigen Beobachtungszeitraum. Eine Verkurzung der Anfalle trat bei 46% (funf von elf) der Patienten ein. Die Anfallsintensitat verringerte sich gleichzeitig bei 64% (sieben von elf), bei drei Patienten (27%) gab es keine Besserung, eine Person (9%) klagte uber eine Anfallsintensivierung. Schlussfolgerung: Die Radiotherapie bei pharmakoresistenten Epilepsien bewirkte dauerhaft einen relativ hohen Ruckgang der Anfallsfrequenz und stellt damit fur Patienten mit operativen Kontraindikationen bzw. nicht anhaltend effektiven epilepsiechirurgischen Eingriffen eine geeignete Alternative dar.

Advances in our understanding of the molecular biology of human epileptogenesis and secondary hyperexcitability have resulted in part from the development and characterization of animal models of mesial temporal lobe epilepsy, trauma-induced epilepsy, and age-specific models of febrile seizures and neonatal hypoxia-induced seizures. Each of these models displays similarities to and differences from their human counterparts and will undoubtedly prove useful for evaluating novel therapies aimed at preventing the development, or halting the progression, of epilepsy or insult-induced secondary hyperexcitability. This article briefly reviews those models that most closely parallel human mesial temporal lobe epilepsy, trauma-induced epilepsy, febrile seizures, and hypoxia-induced seizures. Particular attention is paid to the underlying pathology, the presence or absence of a latent period, and development of spontaneous seizures.

Summary: Purpose: To compare the localizing yield of sphenoidal electrodes placed under fluoroscopic guidance (SEs) and anterior temporal electrodes (ATEs) in ictal recordings from a group of patients with seizure disorders of anterior temporal origin. Methods: We compared ictal recordings of 156 seizures obtained with SEs and ATEs from 40 consecutive patients with seizures of anterior temporal origin. Four electroencephalographers reviewed ictal recordings independently and blind to the patients' identity, presurgical data, and inclusion of ATEs or SEs. Outcome variables included (a) number of correctly localized seizures with SE and ATE recordings by at least three raters; (b) number of ictal foci in which all seizures were localized only with SEs; and (c) number of seizures in which SEs identified the ictal onset ≥5 s earlier than ATEs. Results: Interrater agreement among the four raters was significantly greater with SE than with ATE recordings (p < 0.0001). The number of seizures correctly localized was significantly greater with SEs (n = 144) than with ATEs (n = 99; p < 0.0001). All the seizures [n = 36 (23%)] originating from 14 ictal foci (29%) in 11 patients (27.5%) were localized only with SEs. Finally, the ictal onset was detected at SEs ≥5 s earlier than at ATEs in 67 (43%) seizures originating from 33 (69%) foci in 30 (75%) patients. Conclusions: SEs improve interrater agreement in the localization of seizures of anterior temporal origin, and in about one fourth of patients, SEs add ictal data not identified by ATEs.

To study the influence of interictal spikes on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), EEG monitoring was performed during PET scanning in 21 patients with temporal lobe epilepsy. Asymmetry indices were calculated in the polar, mesial, anterior-lateral, mid-lateral and posterior-lateral temporal region of interests of FDG-PET (PET-AI). 70.7% of spikes were recorded with their maximum at the anterior temporal region (F7, F8, FT9, FT10), 29.3% at mid-temporal (T7, T8), and none at posterior temporal region (P7, P8). Regardless of the side of epileptic focus, right-left difference of the total spikes had a significant negative correlation with right/left PET-AIs of the anterior-lateral temporal region (Spearman’s ρ = –0.565, p = 0.009), polar (ρ = –0.500, p = 0.021) and whole temporal region (ρ = –0.480, p = 0.028). FDG-PET hypometabolism may reflect not only a permanent functional deficit but also a transient regional cerebral dysfunction related to the occurrence of interictal spikes.

Research with adults with epilepsy consistently indicates deficits in executive function (EF). There is less research specific to children with epilepsy and EF. The purpose of this study was to consider EF deficits in children with complex partial epilepsy and complex partial with secondary generalization epilepsy with onset localized to the frontal or temporal lobes. This was a retrospective study of 28 children followed in an outpatient pediatric epilepsy clinic who were consecutively referred for neuropsychological assessment, which included measures of EF. The sample was predominantly White and male, with a mean age of 12.88 years (SD = 1.64) and mean cognitive ability of 89.39 (SD = 13.41). Comparison of right-temporal, left-temporal, and frontal groups yielded significant differences (p = .01) between the left-temporal and frontal groups on the Wisconsin Card-Sorting Test (WCST) Categories with the frontal group demonstrating the greatest deficits. Although mean differences were not significant, the frequency of impaired performance by the frontal group on the Attention/Concentration Index was greater than in the temporal groups. Results indicate that for children with complex partial and complex partial with secondary generalized seizures localized to the frontal and temporal lobes, there is an increased likelihood for impaired EF evident on the WCST, but not on others. Implications of these findings for prevention and intervention are discussed.

Some patients with epilepsy not controlled by medication will benefit from surgical removal of the seizure focus in the brain, if the seizure focus can be identified. The seizure focus has to be localized in one hemisphere only. This is referred to as refractory complex partial epilepsy. The problem

Immunologic disorders related to anticonvulsant therapy have been described in the last three decades, including cellular and humoral alterations that result in recurrent infections; however, the physiopathologic mechanisms are not completely understood. This report describes a patient with complex partial epilepsy and hypogammaglobulinemia while in treatment with carbamazepine, with significant improvement in clinical signs and laboratory tests after substitution to sodium valproate. The authors stress the importance of clinical and laboratory evaluation of patients in continuous anticonvulsant therapy, including immunoglobulins levels and peripheral blood evaluations. As alterações imunológicas relacionadas ao uso de anti-convulsivantes têm sido descrita há três décadas, envolvendo alterações celulares e humorais, sendo os mecanismos fisiopatológicos ainda não totalmente elucidados. Este relato descreve o caso de paciente portador de epilepsia parcial complexa com hipogamaglobulinemia durante o tratamento com carbamazepina, tendo apresentado melhora clínica e laboratorial importantes após substituição da droga pelo ácido valpróico. Os autores ressaltam a importância do acompanhamento clínico e laboratorial, incluindo avaliação dos níveis de imunoglobulinas e hemogramas seriados dos pacientes em uso contínuo de anticonvulsivantes.

Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988–1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.